Provider Demographics
NPI:1205610995
Name:SALEH, BASSAM NEZAM (DMD)
Entity type:Individual
Prefix:
First Name:BASSAM
Middle Name:NEZAM
Last Name:SALEH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6180 WILES RD APT 3-306
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4304
Mailing Address - Country:US
Mailing Address - Phone:954-670-9950
Mailing Address - Fax:
Practice Address - Street 1:888 NE 126TH ST STE 203
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-4964
Practice Address - Country:US
Practice Address - Phone:305-893-0902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN27933122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist